The contributions of focused attention and open monitoring in mindfulness-based cognitive therapy for affective disturbances: A 3-armed randomized dismantling trial
Open accessAbstract
Objective: Mindfulness-based cognitive therapy (MBCT) includes a combination of focused attention (FA) and open monitoring (OM) meditation practices. The aim of this study was to assess both short- and long-term between- and within-group differences in affective disturbance among FA, OM and their combination (MBCT) in the context of a randomized controlled trial. Method: One hundred and four participants with mild to severe depression and anxiety were randomized into one of three 8-week interventions: MBCT (n = 32), FA (n = 36) and OM (n = 36). Outcome measures included the Inventory of Depressive Symptomatology (IDS), and the Depression Anxiety Stress Scales (DASS). Mixed effects regression models were used to assess differential treatment effects during treatment, post-treatment (8 weeks) and long-term (20 weeks). The Reliable Change Index (RCI) was used to translate statistical findings into clinically meaningful improvements or deteriorations. Results: All treatments demonstrated medium to large improvements (ds= 0.42–1.65) for almost all outcomes. While all treatments were largely comparable in their effects at post-treatment (week 8), the treatments showed meaningful differences in rapidity of response and pattern of deteriorations. FA showed the fastest rate of improvement and the fewest deteriorations on stress, anxiety and depression during treatment, but a loss of treatment-related gains and lasting deteriorations in depression at week 20. OM showed the slowest rate of improvement and lost treatment-related gains for anxiety, resulting in higher anxiety in OM at week 20 than MBCT (d= 0.40) and FA (d= 0.36), though these differences did not reach statistical significance after correcting for multiple comparisons (p’s= .06). MBCT and OM showed deteriorations in stress, anxiety and depression at multiple timepoints during treatment, with lasting deteriorations in stress and depression. MBCT showed the most favorable pattern for long-term treatment of depression. Conclusions: FA, OM and MBCT show different patterns of response for different dimensions of affective disturbance. Trial registration: This trial is registered at (v NCT01831362);www.clinicaltrials.gov.
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Dismantling trials used to understand mechanisms of mindfulness-based interventions have produced mixed results.
“State-of-the-art dismantling trials are increasingly used to further mechanistic understanding of MBIs, though studies have produced mixed results [26,27,57,58].”
A dismantling study found unique benefits of mindfulness (monitoring with acceptance) delivered via smartphone app compared with active control (monitoring without acceptance) on some but not all psychological outcomes, including reduced momentary but not retrospective loneliness.
“By contrast, another dismantling study found evidence for unique benefits of mindfulness (monitoring experience with acceptance) delivered through a smartphone app compared to an active control dismantling condition (monitoring experience without acceptance) on some but not all psychological outcomes (for example, mindfulness reduced momentary but not retrospective loneliness61,98).”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [98]
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Britton, W. B., Desbordes, G., Acabchuk, R. L., Peters, S., Lindahl, J. R., Canby, N. K., Vago, D. R., Dumais, T., Lipsky, J., Kimmel, H. J., et al. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.730972 · Cited by 81 · see citing works
Self-citationHuberty, J., Puzia, M., Green, J., Vlisides‐Henry, R. D., Larkey, L., Irwin, M. R., & Vranceanu, A. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2021.09.004 · Cited by 73 · see citing works
A common factors perspective on mindfulness-based interventions
Goldberg, S. B. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-022-00090-8 · Cited by 75 · see citing works
Gallagher, S. (2023) · doi:10.1093/oso/9780198873068.001.0001 · Cited by 67 · see citing works
Brown, K. W., Berry, D. R., Eichel, K., Михайловна, Б. П., Rahrig, H., & Britton, W. B. (2022) · Psychophysiology · doi:10.1111/psyp.14024 · Cited by 42 · see citing works
Self-citationHitchcock, P. F., Britton, W. B., Mehta, K. P., & Frank, M. J. (2022) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-022-01033-9 · Cited by 30 · see citing works
“…the 8-week pre-to postintervention period, the three interventions led to similar improvements in clinical outcome variables (Britton et al., 2018; Cullen et al., 2021) and comparable effects on self-reports in an emotional reactivity task, although with distinct effects on neural measures during…”
BackgroundMethodResultInfluentialSelf-citationImpact of warm mindfulness on emotion regulation: a randomized controlled effectiveness trial
Gawande, R., Smith, L., Comeau, A., Creedon, T. B., Wilson, C. L., Griswold, T., Cook, B. L., Loucks, E. B., & Schuman-Olivier, Z. (2023) · Health Psychology · doi:10.1037/hea0001303 · Cited by 24 · see citing works
Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials
Kim, D.-Y., Hong, S.-H., Jang, S.-H., Park, S., Noh, J.-H., Seok, J.-M., Jo, H.-J., Son, C., & Lee, E. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031244 · Cited by 24 · see citing works
“Affective disorder [89] MBCT (M) 104 (3, focused attention, open monitoring) 8 depressive mood A, feeling anxious A, stress A”
BackgroundSchlosser, M., Barnhofer, T., Requier, F., Deza-Araujo, Y. I., Abdoun, O., Marchant, N. L., Chételat, G., Collette, F., Klimecki, O., Antoine Lutz, A., et al. (2022) · Mindfulness · doi:10.1007/s12671-021-01816-0 · Cited by 20 · see citing works
Psychedelic-Assisted Psychotherapy and Mindfulness-Based Cognitive Therapy: Potential Synergies
Chambers, R., Stoliker, D., & Simonsson, O. (2023) · Mindfulness · doi:10.1007/s12671-023-02206-4 · Cited by 13 · see citing works
“For example, an MBCT dismantling study by Cullen et al. (2021) showed that the full MBCT intervention (which progresses from focused attention to open awareness) resulted in greater mood improvement than focused attention or open awareness alone.”
InfluentialChan, R. M. K., Mak, W. W. S., & Yu, B. C. L. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20085470 · Cited by 11 · see citing works
“It increases the activity of the parasympathetic system to reduce stress responses [23], improves the efficiency of gas exchange in the lungs [24], increases cognitive flexibility [25], and alleviates anxiety and stress [26].”
BackgroundReconceptualizing the relationship between anxiety, mindfulness, and cognitive control
Gupta, R. S., Heller, W., & Braver, T. S. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106146 · Cited by 6 · see citing works
“Cullen et al. (2021) assessed both short-and long-term between-and within-group differences in affective disturbance among FA, OM, and their combination (MBCT) within the context of a randomized controlled trial.”
Cummins, D. D., Schulman, Z., Maher, C., Tortolero, L., Saad, A. E., Martinez, L. N., Davidson, R. J., Marcuse, L. V., Sáez, I., & Panov, F. E. (2024) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2024.110150 · Cited by 5 · see citing works
Godara, M., & Singer, T. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13113295 · Cited by 5 · see citing works
“State-of-the-art disman-tling trials are increasingly used to further mechanistic understanding of MBIs, though studies have produced mixed results [26,27,57,58].”
BackgroundTsang, A. P. L., Lu, H.-J., & Lo, H. (2023) · Mindfulness · doi:10.1007/s12671-023-02292-4 · Cited by 4 · see citing works
“As FA and OM meditations are active components in Mind-fulness-based Stress Reduction or Mindfulness-based Cognitive Therapy (Cullen et al., 2021), future studies are encouraged to implement manualized mindfulness-based interventions to further confirm whether mindfulness can result in more…”
Singh, S., Cunningham, J. E. A., Uher, R., Becker, S., & Nunes, A. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106652 · Cited by 3 · see citing works
Nash, C. (2024) · Journal of Ageing and Longevity · doi:10.3390/jal4040034 · Cited by 3 · see citing works
“Mindfulness training focuses on attentional control of internal conditions [46], representing monitoring practiced during episodes of depression and anxiety [47].”
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0007 · Cited by 1 · see citing works
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0001 · Cited by 1 · see citing works
Nash, C. (2024) · Preprints.org · doi:10.20944/preprints202406.0304.v1 · Cited by 1 · see citing works
اليقظة الذهنية وعلاقتها بالجهد الانفعالي لدى العاملين في مجال الصحة النفسية
الغرايبة, م. م., & الشريفين, أ. ع. ا. (2022) · IUG Journal of Educational and Psychological Studies · doi:10.33976/iugjeps.30.2/2022/7
الله, م. خ. م. ع. (2023) · مجلة جامعة الفيوم للعلوم التربوية والنفسية · doi:10.21608/jfust.2023.310530
The Cruel and Unusual Phenomenologies of Torture and Solitary Confinement
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0011
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0008
Disorder, Dissociation, and Disruption in Self-narrative
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0006
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0003
Mindfulness in the Self-pattern
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0010
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.002.0004
Dynamical Relations in the Self-pattern and Psychopathology
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0005
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.002.0007
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.002.0008
Artificial Transformations of the Self-pattern
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0009
A Threefold Method for Studying Self-pattern Dynamics
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0004
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.003.0002 · Cited by 1 · see citing works
Gallagher, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780198873068.002.0003
Silva, G. O. D. S., de Medeiros, P. C. B., Santos, L. P., & Sousa, M. C. D. C. (2024) · Suma Psicológica · doi:10.14349/sumapsi.2025.v32.n1.1
Exploring the therapeutic convergence of meditation, psychedelics, and MDMA
Dines, J. T. (2025) · Journal of Psychedelic Studies · doi:10.1556/2054.2025.00435
Alone in Thought: The Risks of Meditation from a Psychotherapeutic Perspective
Wepner, J. (2025) · Psychoanalytic Perspectives · doi:10.1080/1551806x.2024.2439359
“Focused attention is the preferred type for most Westerners’ goals of stress management, as it increases one’s ability to concentrate and feel less distracted (Cullen et al., 2021; Lohani et al., 2020).”
InfluentialAIZEN Digital Meditation Intervention for Caregiver Burnout in Taiwan—A Pilot Randomized Trial
Chen, Y., Liu, C.-C., Chen, Y.-C., Hsiao, Y.-P., Lee, K.-H., Chiou, H., Yen, C.-M., & Chung, R. (2026) · Mindfulness · doi:10.1007/s12671-026-02854-2
The Role of Meditation in Shaping Resilience
Mo, R., Liu, C., & Hao, J. (2026) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.70300
“Clinical evidence suggests that 8-week FAM interventions significantly alleviate anxiety, stress, and depression symptoms, with more rapid efficacy onset compared to OMM [ 4, 6 ].”
Influential
- Authors
- Cullen, B., Eichel, K., Lindahl, J. R., Rahrig, H., Kini, N., Flahive, J., & Britton, W. B.
- Affiliations
- Brown University (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Britton, Willoughby B.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-01-12
- Volume
- 16
- Issue
- 1
- Pages
- e0244838
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7802967
- OpenAlex
- W3120547434
- Cited by
- 43
- References
- 70
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 22 · 2022: 6 · 2021: 3
- FWCI
- 6.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship@UMassChan (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Brown University
- Mind and Life Institute
- National Institutes of Health (K23-AT006328-01A1)
- Office of Behavioral and Social Sciences Research
- National Center for Complementary and Integrative Health (UH2AT009145, K23AT006328, grant UH2AT009145)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- mindfulness-based cognitive therapy, focused attention meditation, open monitoring meditation, depression, anxiety, mood disorders, treatment deterioration, long-term treatment outcomes, stress
- MeSH terms
- Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Mindfulness
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